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L0301P104 - Culture and Health Behaviour
Culture and Health Behaviour Culture a “way of life” that is socially transmitted from generation to generation, but can change drastically over time systems of ideas, beliefs, values and practices of a particular social group most cultures also have subcultures generally learnt from people around you  Importance Australia is a multicultural society 26% of Australians born overseas understanding of health and disease vary minority groups often receive: poorer health care misdiagnosis higher readmission rate higher contact rates post-discharge effective doctor-patient communication and cultural competence linked with improved patient satisfaction as a health practitioner, no choice of patient  Culture and Health culture impacts upon understanding of health e.g. belief systems separation of mind, body and spirit in Western cultures e.g. community structure individualist versus collectivist Culture and Health Behaviour symptom expression how people describe what is going on symptom interpretation and explanation what needs/does not need to be treated pain - some cultures view it as punishment lifestyle factors diet, alcohol use, sedentary behaviour help seeking behaviour communication patterns treatment expectations Cultural Safety refers to the patient’s feelings in the health care encounter health care provider should reflect on their identity, values, difference between cultures culturally safe practice implies the ability to keep these differing perspective in mind whilst treating the patient as a person worthy of respect in his/her own right Cultural Competence refers to the attitudes, knowledge and skills of practitioners necessary: to become effective health care providers for patients from diverse backgrounds to ensure patients feel safe acknowledgement of the importance of culture in people’s lives awareness of one’s own values and perceptions (including stereotypes, biases) understanding importance of social/cultural influences on patients’ health and consider how these factors effect health care respect for cultural differences, avoidance of “othering” minimisation of negative consequences of cultural differences   Power Differentials refers to when: patient goes waits to see the practitioner more passive in the medical encounter practitioner: is seen as “the expert” has power to “tell patient what to do” is highly respected is more knowledgeable and knows more than the patient Old Approach to Cultural Competence directly learning methods for caring for “asian” and “hispanic” patients do’s and don’t’s led to stereotyping and no way to learn every culture New Approach to Cultural Competence awareness of cross-cutting cultural and social issues and health beliefs learn from individual patients decision making processes negotiating styles of communication e.g. eye contact and disclosure roles in families appreciation of mistrust, prejudice, racism barriers to healthcare Interpreters talk to the patient not the interpreter avoid using family members orient the interpreter before and debrief Examples Malaysia ambivalence towards health less interest in lifestyle changes over-reliance on medication doctors are in a position of power expected to be paternalistic/authoritative delayed help-seeking and sick leave is rare less resources for healthcare China less primary healthcare, people generally go to emergency department for help Singapore high socioeconomic status linked with greater help-seeking treatment with focus on physical symptoms more paternalism from physicians Australia healthcare is a right more holistic - social history, mental health and alternative therapy avoid power differentials - informed consent Refugees Primary Healthcare Needs compared with non-refugees, refugees: 23% more likely to present to ED 47% more likely to be admitted to hospital more likely to be discharged from hospital with mental illness, obstetric complication (genital mutilation), infectious diseases many gaps in data e.g., understanding health care access and decisions, barriers to care Trauma variable presentations quiet, withdrawn behaviour intrusive thoughts, nightmares agitated, hyper-vigilant issue of “pathologising” normal responses traumatised communities community approach to intervention importance of coping and adaptation   Hmong People ethnic Chinese from in south east Asia fought against communists in the Laotian civil war and were persecuted after the war Definition of Health being able to work, being fat, light bones, firm muscles, good bodily fluid Understanding of Illness sickness caused by: natural forces e.g., imbalance of yin/yang, wind, heredity, germs, chemicals in food spiritual or supernatural forces e.g., offending spirits, soul loss, encounter with menacing spirits Understanding of Health Treatments natural restore balance to yin/yang releasing bad blood with massage, cupping, acupuncture, herbal medicine and western medicine spiritual healing administered by shaman, family members, ministers and physicians biomedical treatments may be refused   Cancer high rates of cancer, often only detected in late stages do not screen for cancer often due to fatalistic beliefs - cancer is due to spirits patriarchal system - man in the house chooses whether medical help is sought modesty/stigma mistrust of western medicine strategies to improve screening include husbands in discussion of women’s health development of cancer literacy material accessible by the community work with shaman/healers, community leaders and within cultural group female clinicians for modesty concerns involving SE Asian medical practitioners Suicide and Culture suicide rates vary by cultural group Aboriginal/Torres Straight Islander > Non Aboriginal/Torres Straight Islander White > Black (USA) Risk Factors some are consistent across cultures e.g. previous attempts, low SES, substance abuse, access to means others vary between cultures developed: males > females, single > married, religiosity = protective (Catholic) developing: female > male (China), single = married (China, India), religiosity = not protective (Hinduism, Buddhism)